Borgan Saif M, Romeus Laniel, Rahman Saleh, Asmar Abdo
Internal Medicine, University of Central Florida College of Medicine, Orlando, USA.
Epidemiology and Public Health, University of Central Florida College of Medicine, Orlando, USA.
Cureus. 2020 Feb 4;12(2):e6876. doi: 10.7759/cureus.6876.
Background Defensive medicine is becoming increasingly prevalent in the United States and is estimated to cost billions of dollars in excess healthcare spending. There is evidence that the practice of defensive medicine starts early in the medical career. Defensive medicine has been investigated among residents in high medico-legal risk specialties, but there is a paucity of information on its prevalence among internal medicine residents. Objective To examine the prevalence and patterns of defensive medical practices among internal medicine residents. Methods We conducted an online survey among the residents of three internal medicine residency programs in the 2018-2019 academic cycle. We invited all internal medicine residents within the selected programs to participate through email and asked them to complete an electronic survey assessing defensive medical practices. Results A total of 49 out of 143 residents participated in the study (response rate: 34.3%); 55% (n = 27) of the residents who participated considered the risk of being sued during residency to be low, compared to 40.8% (n = 20) who considered it to be moderate and 4.1% (n = 2) who considered it to be high. Defensive medical practices were found to be widely prevalent (40.0-91.3%) among internal medicine residents across all three clinical training stages. Assurance defensive practices were more common than avoidance practices. Conclusion Defensive medical practices, especially of the assurance type, were widely prevalent among our sample of internal medicine residents.
背景 防御性医疗在美国正变得越来越普遍，据估计，其导致的医疗保健支出超支达数十亿美元。有证据表明，防御性医疗行为在医疗职业生涯早期就已出现。防御性医疗已在高医疗法律风险专科的住院医师中得到研究，但关于其在内科住院医师中的流行情况的信息却很少。目的 研究内科住院医师中防御性医疗行为的流行情况和模式。方法 在2018 - 2019学年期间，我们对三个内科住院医师培训项目的住院医师进行了一项在线调查。我们通过电子邮件邀请所选项目中的所有内科住院医师参与，并要求他们完成一项评估防御性医疗行为的电子调查。结果 143名住院医师中共有49人参与了该研究（回复率：34.3%）；参与研究的住院医师中，55%（n = 27）认为住院期间被起诉的风险较低，相比之下，40.8%（n = 20）认为风险中等，4.1%（n = 2）认为风险较高。在所有三个临床培训阶段的内科住院医师中，防御性医疗行为被发现广泛存在（40.0 - 91.3%）。保证性防御行为比回避性防御行为更常见。结论 在我们的内科住院医师样本中，防御性医疗行为，尤其是保证性防御行为广泛存在。
